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Mar 8 Contraceptive methods in Japan

Dr Orito is a gynecologist and obstetrician who has his own clinic located in Ikebukuro, Tokyo. He has studied and worked abroad and speaks English, French, Chinese and Japanese. His patients are Japanese and foreigners. In this interview, he clarifies what the contraceptive methods are in Japan and how get them.

1. Dr Orito, can you please introduce yourself?

My name is Seiya Orito. I’m a Japanese obstetrician and gynecologist with 15 years of experience. I have been certified by the Japan Society of Obstetrics and Gynecology. I have lived in Colombo, Sri Lanka and New York, before entering the University of Tokyo. During university, I took a leave of absence and studied abroad at the Ohio State University and Harvard University to brush up my English skills. I have also learned French. So I’m happy to say that I can now speak English, French, Chinese as well as Japanese. I have opened my own practice in 2015 at Higashi (East)-Ikebukuro, Tokyo.

2. What are the contraceptive methods used in Japan?

The most popular method of contraception in Japan is condom, and then oral low-dose pills. Recently, the use of Mirena (R) an IUD (intrauterine device) seems to be increasing. As far as I know, implant and diaphragms are not available in Japan.

If you are young, have not given birth, and do not smoke, I recommend taking the low-dose pills, because it is easy to start and to quit if you wish to. If you have given birth and/or smoke, you may choose an IUD.

3. Where and how to get them?

In Japan, prescription of pills, including emergency contraception pills, require a doctor's visit. Hospitals tend to prescribe as out-of-hospital prescription while clinics tend to prescribe as in-house prescription.

Usually before the consultation, a questionnaire will be given to you with the basic questions (height, weight, age, etc.). The doctor’s check up goes over your history and appropriate tests and exams required to prescribe the contraceptive pill.

4. How much does it cost?

The low-dose pills are not covered by the Japanese health insurance. For one sheet of low-dose pills, you are charged around 3,000-3,500 yen if in-house prescription. You can be prescribed several sheets in a visit.

As for the emergency contraception pills (the morning after pill - kinkyû hinin piru), you are charged around 10,000 yen for the Yuzpe method (two doses every 12 hours) and around 20,000 yen for Norlevo (R) (only one dose). The first one tends to have more side effects than the second one.

It may sound strange, but if you suffer from dysmenorrhea (painful periods), you can be prescribed other kinds of low-dose pills covered with the health insurance. However, it ends up in paying almost the same amount, if not higher. You can be prescribed only a sheet (one month amount) every month.

Insertion of Mirena (R) is around 25,000-30,000 yen, provided that one suffers from dysmenorrheaand hypermenorrhea (excessive menstruation). If not covered with the health insurance, one is charged 40,000-60,000 yen.

5. Why are these methods most of the time not reimbursed by Japanese health insurance?

To explain the Japanese health insurance system briefly, there are two major plans: the National Health Insurance (Kokumin Kenko Hoken) and the Employee's Health Insurance (Shakai Hoken). The medical fees applicable to the health insurance system are the same all over Japan. Usually, a patient pays 30% of the total fees at a medical institution, while the institution requests reimbursement for the 70% part the following month. The percentage a patient pays is different (less) for the elderly people or a single-female parent household. You do not need to collect and send the receipts for reimbursement. While medical services related with treating diseases are covered, those of preventive medicine, pregnancy, delivery of a baby, contraception, and aesthetic medicine are not. In some services, sometimes they are covered and sometimes not. The service is covered with the insurance only if a patient is diagnosed of a particular disease that is applicable.

6. There is a “myth” about the pill in Japan. People say that it is not very common and that they are from the old generation compared to the ones used in western countries. What is the truth, can you please explain us?

Doctors of older generation tend to believe that taking hormones is of high risk. Famous side effect is deep venous thrombosis (DVT) which is true with the medium-dose pills. However, the risk is considered low enough to take the low-dose pills for a long period of time.

This explains why the introduction of the low-dose pills was relatively late in Japan as compared with other countries. In 1999, the low-dose pills not covered with the health insurance were approved by the Ministry of Health, Labour and Welfare. It was not until 2008 that the low-dose pills covered with the health insurance were approved. There still exists doctors who prescribe only the medium-dose pills because they are only familiar with the medium-dose. Such doctors are reluctant to prescribe it for a long period of time. But I would say that doctors in their 40s or younger are familiar with the low-dose pills.